A national review of the Army's behavioral health workforce outlines delays in care, inaccurate diagnoses and a need for more workers.

SEATTLE — Problems with combat stress in soldiers have escalated so rapidly that the Army has doubled its behavioral health workforce over the last five years and still needs to hire more help, according to a nationwide review of the military's troubled system for handling the mental wounds of war.

The review, released Friday, said about 4% of those returning from combat come home with behavioral health problems. In seeking help, they face a confusing array of programs, inconsistencies in training for mental health workers and gaps in mental health records because of uncoordinated record-keeping systems.

Army officials say they are already moving to correct some of the problems identified in the report, commissioned after a record number of suicides and complaints by soldiers at the Madigan Army Medical Center that their diagnoses of post-traumatic stress disorder and related medical benefits were being inappropriately reversed. The medical center is located on Joint Base Lewis-McChord just outside of Tacoma, Wash.

Lt. Gen. Howard B. Bromberg, deputy Army chief of staff, says commanders are moving behavioral health specialists into combat zones to give immediate aid to soldiers. They are also reducing delays in processing for those seeking help for behavioral health problems, many of whom must wait more than a year for their cases to be finalized.

"The Army is committed to taking care of our soldiers, who have given so much to our nation over the last 12 years of war," said Lt. Gen. Patricia Horoho, the Army's surgeon general.

Sen. Patty Murray (D-Wash.), former chairwoman of the Senate Veterans Affairs Committee, had sought the report after concerns were raised that a screening team of forensic psychiatrists at Madigan were refusing PTSD diagnoses for service members who had been clearly identified with such problems by their own Army counselors and psychiatrists.

"The sheer number of changes this report recommends is indicative of the size and scope of the problem. This report lays out shortcomings in diagnosing, identifying and providing standardized care for PTSD and a wide range of behavioral health issues," Murray said in a statement.

"It also focuses on the painfully long delays that have plagued a joint disability system that many service members and their families have given up on," she said.

Overall, Murray's office found that more than 40% of the diagnoses of PTSD for patients under consideration for medical retirement at Madigan had been overturned by a forensic psychiatry screening team — the only one of its kind operating at a major Army medical hub.

But Army officials said the review, expanded to include behavioral health at Army facilities worldwide, did not turn up evidence of substantial false PTSD claims, or that financial issues were playing a role in combat stress diagnoses.

"We didn't see anything in this look that was related to monetary incentives in the system," Bromberg said.

In a review of more than 154,000 behavioral health cases across the Army, independent reviewers agreed with 88% of the PTSD diagnoses. Because mental healthcare "is an art and a science," differences in diagnoses between providers are not unusual, Horoho said.

In the remaining 12% of cases, independent reviewers disagreed with the original diagnosis. The initial variance rate at Madigan, where the forensic psychiatry team was at work, was 21%.

"This revalidation rate is extraordinary when you compare it to the diagnostic revalidation rates from the civilian sector," Horoho said.

She emphasized that the study found no inappropriate actions on the part of the forensic team at Madigan. Rather, she said, the team was dismantled in order to ensure that service members at all medical centers were receiving the same diagnosis regime.